SPC365

Beyond Structural Stability: Ongoing Electrical Remodeling in ATTR-CM Treated With Tafamidis

Session: Sessão de Posters 12 - Estratégias terapêuticas e desfechos em vida real na ATTR-CM
Speaker: Rita Ventura

Congress: CPC 2026
Topic: L. Cardiovascular Pharmacology
Theme: 31. Pharmacology and Pharmacotherapy
Subtheme: 31.1 Cardiovascular Pharmacotherapy
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Rita Ventura; Inês Brito e Cruz; Maria João Primo; Didier Martinez; Vanessa Lopes; João Rosa; Manuel Oliveira Santos; Maria João Ferreira; Lino Gonçalves

<p><strong>Introduction:&nbsp;</strong>Tafamidis improves survival in transthyretin cardiac amyloidosis (ATTR-CM),</p>

<p>but detailed real-world characterization of its longitudinal clinical, electrical, and structural</p>

<p>effects remains limited. Clarifying disease progression under tafamidis in routine care is</p>

<p>essential.</p>

<p><strong>Purpose:</strong>&nbsp;To describe 12-month changes in functional status, biomarkers, ECG parameters,</p>

<p>and echocardiographic structure/function in patients with ATTR-CM treated with tafamidis.</p>

<p><strong>Methods:&nbsp;</strong>Retrospective observational study of patients with ATTR-CM treated with tafamidis.</p>

<p>NYHA class, NT-proBNP, ECG variables (PR interval, QRS duration, QRS voltage pattern,</p>

<p>new-onset atrial fibrillation), and echocardiographic parameters (wall thickness, LVEF, GLS,</p>

<p>diastolic indices, and LA volume index) were assessed at baseline and 12 months.</p>

<p><strong>Results:&nbsp;</strong>Forty-five patients initiated tafamidis (median age 83 years; 80% male).</p>

<p>Hypertension (88.9%) and atrial fibrillation (AF) (60%) were frequent; 22.2% had prior</p>

<p>pacemaker implantation. Population baseline finding included mild functional impairment,</p>

<p>elevated NT-proBNP, prolonged QRS duration, and typical structural findings.</p>

<p>NYHA class remained stable (median &Delta; 0.0 [&ndash;1.0 to 0.0], p = 0.491), though 35.7% improved.</p>

<p>NT-proBNP showed marked inter-individual variability without a consistent trend (median &Delta;</p>

<p>+376 pg/mL [&minus;1332 to +750], p = 0.807).</p>

<p>Electrically, PR interval remained stable (median &Delta; +4 ms [&minus;38 to +19], p = 0.866), while QRS</p>

<p>duration increased significantly (&Delta; +7 ms [3.5 to 17.8], p = &lt; 0.001).</p>

<p>Despite tafamidis therapy, new-onset AF emerged in 32% of previously non-AF patients.</p>

<p>Echocardiographic parameters remained largely unchanged: LVEF (&Delta; &minus;2.0% [&minus;7.0 to +3.0], p</p>

<p>= 0.363), septal thickness (&Delta; 0.0 mm [&minus;1.0 to 0.5], p = 0.518), posterior wall thickness (&Delta; +1.0</p>

<p>mm [&minus;2.77 to +1.85], p = 0.916), LV mass index (&Delta; +2.7 g/m&sup2; [&minus;40.6 to 19.4], p = 0.893), GLS</p>

<p>(&Delta; +2.6% [&minus;2.16 to +9.60], p = 0.500), E/e&prime; (&Delta; +3 [&minus;5.75 to +5], p = 0.713), and LA volume</p>

<p>index (&Delta; +3 mL/m&sup2; [&minus;1.5 to 13.5], p = 0.195).</p>

<p><strong>Conclusion:&nbsp;</strong>Tafamidis stabilizes structural, functional, and biomarker profiles in real-world</p>

<p>ATTR-CM, but electrical disease continues to progress, with significant QRS widening and</p>

<p>frequent new-onset AF. These findings highlight persistent electrophysiological vulnerability</p>

<p>and support routine ECG monitoring, as well as validation in larger cohorts.</p>

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